الفهرس 
Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
Type 1 diabetes mellitus (T1DM) is one of the most
common chronic diseases in pediatric patients. The
incidence of T1DM among children is rising worldwide.
The overall annual increase is estimated at 3% with
approximately 70,000 children worldwide expected to
develop T1DM every year.
Patients with T1DM are at high risk of developing
other autoimmune diseases, such as autoimmune thyroiditis
(AIT) and celiac disease (CD) Moreover, T1DM can lead
to numerous complications in pediatric patients.
Autoimmune thyroid disease (AITD) is the most
frequent autoimmune disease associated with type 1
diabetes mellitus.
The prevalence of thyroid autoantibodies in children
with type I DM varies between 3% and 50% in different
countries. Progression to overt thyroid disorders in
individuals with significant titers of anti- TPO occurs in
about 50% of them within 3-4 years. So, serological
screening for autoimmune thyroid disease should be
performed in all T1DM patients by means of antibodies at
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T1DM onset and thereafter every second year according to
ISPAD recommendations.
The study aimed to co-relate the presence of Antiinsulin
Antibody and / or Anti -thyroid Antibodies (Anti-
TPO and/or Anti-TG) in type 1 diabetic patients regularly
attending the pediatric diabetes clinic at Ain Shams
University with the short and long term complications.
It was conducted in the period from October 1st 2013
till June 4th 2014 and included 151 children and
adolescents with type 1 DM, who were regularly followed
up in the clinic, they were 73 males (48.3%) and 78
females (51.7%), their ages ranged from 2 -17 years with
mean age 10.963.95 years and their disease duration
ranged from 0.1- 16 years with mean of 3.84 3.41 year.
All patients were subjected to: full history taking,
thorough clinical examination and laboratory investigation
including: HbAc1%, Serum Anti insulin Antibody, Anti
TPO Antibody and Anti-TG Antibody.
The results of the study showed:
- Percentage of female patients in the study was slightly
higher than males.
- Almost forty percent (39.7%) of our studied population
had family history of Diabetes whether type 1 or type 2.
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148
- Eleven patients (7.3%) had family history of other
autoimmune diseases. While only 2 patients (1.3%)
were found to have other autoimmune diseases than type
1 diabetes.
As for symptoms suggestive of autoimmune thyroid
disease; the most common symptoms encountered were
nervousness and heat or cold intolerance.
- Only 1.3% (2/151) of patients was below the 5th centile
for weight, whereas 9.3% (14/151) were short.
- Three patients of 151 (2%) were hypertensive.
- Thirty patients of out the total group of 151 diabetics
had one or more microvascular complications.
- About three quarters were poorly controlled.
Due to sampling error, 128 patients out of our total
number of patients (151) were serologically screened for
the presence of Anti-insulin Antibodies and Anti-Thyroid
Antibodies.
- Fifty three (53) patients out of (128) were positive for
Anti-insulin Antibody giving a sero-positivity of 41.4%,
whereas 13 patients (10.2%) displayed positive results
for Anti-Thyroid Antibodies, all of them were positive
only for TPO-Ab, 0% was positive for TG-Ab and 4.7%
(6/128) were positive for both anti-insulin and anti-TPO
antibodies.
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149
- No relation was found between positivity of Anti-insulin
antibodies and Anti-TPO antibody titre.
- There was no significant difference in age, gender or
age of onset as regard positivity to any of the antibodies.
- There was significant relation between Anti-TPO
antibody positivity and duration of diabetes. , the
majority of anti-TPO-positive patients (61.5%) had less
than 5 years of diabetes, (15.4%) between 5 and 10
years, and (23.1%) more than 10 years (p=0.053).
- Frequency of diabetics receiving an insulin dose
between 1-2 IU/Kg/day was higher among those
expressing Anti- insulin Antibody positivity. Lower
insulin requirements were observed among those with
negative Anti- insulin Antibody even though there was
no significant relation between insulin requirements and
Anti-TPO positivity (p- value>0.05).
- No relation was found between Antibodies’ positivity
and diabetic ketoacidosis or hypoglycemic attacks.
- Anti- insulin Antibodies are more common in patients
with family history of diabetes.
- No significant relation between Antibodies’ positivity
and family history of other autoimmune diseases.
- No significant relation was found between suggested
autoimmune thyroid disease symptoms and the
positivity of either of the antibodies.
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150
- There was no significant difference in weight, height,
BMI and blood pressure percentiles between patients
showing positivity or negativity to either Anti-insulin
Antibodies or Anti-TPO Antibodies. where (pvalue>
0.05).
- No significant relation was found between Antibodies’
positivity and glycemic control (p- value>0.05).
- Although most of the patients who had Neuropathy
showed positivity to Anti-insulin Antibodies (p-value
<0.05) but no significant relation was found between the
presence of microvascular complications and the
positivity of Anti-TPO Antibodies. Also most of
patients (14/23) with microvascular complications were
seropositive for Anti-insulin antibody titer.
- Anti-insulin antibody differentiated those with
microvascular complication with sensitivity and
specificity of 69.6% and 57% respectively when
considering the cut-off point was 8.95 U/ml.
- significant association was found between serum anti-
TPO antibodies positivity and abnormal serum TSH
levels, we found that in the group of patients with type 1
diabetes and thyroid autoimmunity, 30.8% (4/13)
patients with positive anti- TPO antibodies had
abnormal TSH levels compared with 10.4% (12/115) in
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151
the group with negative anti- TPO (p =0.059). Three had
subclinical hyperthyroidism and one had subclinical
hypothyroidism.
- This study has proved that the screening of
autoantibodies in type 1 diabetic patients could reveal
subclinical cases of autoimmune thyroid disease. It also
has proved that follow-up of patients with positive
autoantibodies is a must because further deterioration of